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HomeMy WebLinkAbout0067DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.15-1-20 BOX 1 .'r r� Lm ELL. 00067 SITE � - 44-11 MCNE MAILING ADDRESS e lad' f o e,J PERSON INTERVIEWED �'A ✓� SC�4 PCHD Camplaint # AJO 44 Name & Relationship (i.e, owner tenant, etc.) DATE M A -<-A 2- 3 ► ( t TYPE FACILITY. /' IL�- �.�►7J�- y PHONE Z Z. S" T � �lPROPOSED INSTALLER '#i-J V A tom C4 -41SZ4 pr K � r�GA c Proposal (include sketch locating all adjacent wells): Nam Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. Proposal a ST,4 i f le ��T ®� Z' u leg, 's Signature & Proposal Disapproved * Date roposal approved, with the following conditions: 1. Procurement of any pawn permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town And Tax Map number. C. Location of installed capponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6'1diam. x 6' deep drywalls surrounded by one foot + gravel). e. Installer's name and number, 3. System repair to be performed in. accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above ditions. SIGNA URE TITLE DATE ! • 7-s� 1 I lam: mite ( ); YetLcw (psi 8I); Pink (Anlicnnt) E DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 December 9. 1992 Paul & Rita Schaffarn PO E,-,-,4 821 Paterson. NY 12563 Re: :proposed addition - Schaff= Sao ling Court iii Patterson Lot #15 Dear `4r. & Mrs. Schaf farn : JOHN KARELL Jr., P.E., M.S. Public Health Director I ha.•.-e received and reviewed the plans for the proposed addition to the above mentioned residence. The clans indicate that a 19' x 16' b" family room will be added to the existing three bed_v-oom residence. The Survey indicates that sufficient area exists to expand or repair the sewage disposal syszem, should it become necessary in the future. Therefore, rased on the information suom'_tted,.the above mentioned addition is APPROVED with the following conditions: 1. ILhe total number of bedrooms must remain at three without prior approval by this 'eoartment. 2. The area or the existing sewage disposal system.. and its expansion area, must be. maintained. 3. All plumbing fixtures must be replaced or updated with water saving devices., i.e.. ow =lush toilets. restrictors for shower heads and faucets: etc. Appr:val is granted for sewage disposai only. Any other permits or variances required ca e tine responsibility of the applicant and the jurisdiction of the Town of Patterson. If Vou have any questions. please contact me at your convenience. Mil _ n cc: BI (T) Patterson Very trL:ly you-s, William Hedges Sr. Public Health Sanitarian DEPARTN46NT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 (914) 278 -6130 TELECOPY COVER SHEET )ATE FROM: PUTNAM COUNTY DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES GENEVA ROAD, ROUTE 312 BREWSTER, NY 10509 iTTENTION: FAX # 914- 278 -6085 JOHN KARELC Jr., P.E. M.S. Public Haaltit Director LUMBER OF PAGES TRANSMITTED (Including cover sheet): - -. TOTES /MESSAGES: :n the event of transmission /reception difficulties, please contact cur office at 914- 278 -6130. DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 December 9, 1992 Re: Proposed addition - Schaffarn Sappling Court (T) Patterson Lot #15 JOHN KARELL Jr., RE, -M.S. Public Health Director Dear Mr. & Mrs. Schaffarn: I haSe received and reviewed the plans for the proposed addition to the above mentioned residence. Y GL )f Vi lA47 .7%.^.&L _2, William Hedges Sr. Public Health Sanitarian WH/jp cc: BI (T) Patterson Any person occupying premises served by the above'= system(s), shall,_ conditwns„ resulting from such usage Approval of:the separate •available and the:ap "proval;of the;prrvate; water- supply shall %become .., subject;tb :modification or .change when in the judgment'of the= Date • <^ / �✓ ryBy r - 8 such acti6n as maybe necessary to secure the COrrection,� Of any - -'- unsanitary im shall become null and vo' l &as soon, as a public sanitary sewer becomes C •whenr a public water supply becomes' available -,Such "approvals ,ate r of Health; 'such revocation; modification:or. change is - :necessary ,'i• ' :'. /' Title ��,�_. a �nrrcha -- A (�m� Building t-: 'Z A16 k�' 1CP Bu lding Constructed By �o u Location — Street V A �),h A:LOAJ Municipality ZE N �'s Section — Ward Block Lot GUARANTY OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the locations workmanshipt material, construction and drainage of the sewage disposal system searing the above described propertyt and that it has been constructed as shown on the approved plan or approved amendment,& of and in accordance with the standardst rules and regulations of the r County Department of Healtht and hereby guaranty to the owners his successorst heirs or assignst to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of completion of the sewage disposal system or any repairs made by me to.such systems except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determ!X&ISIde f th e Director of the Division of Environmental Health Services of the r Canty Department of Health as to whether or not the failure.of the system to operate was caused by the willful or negligent,act of the occupant of the building utilizing the system. Dated this /d' ,day of a-� 194 at- Place & State Signature Title If corporation, give name and address) FIFE (5) COPIES ARE REQUIRED WITH FIVE (5) COPIES OF FINAL PLANS BEFORE CERTIFICATE CAF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM -------------------------------------------- pv�rtiq,.� Dli.sion of Environmental. Health Servicesq der County Department of Health Fcm S.D. 50 January 19 1960 (1971) 1 C fl BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y. WATER ANALYSIS REPORT SAMPLE NO. 3099 SOURCE: Maplewood Estates - faucet - well supply Lot 15 Route 9 Fishhillo N.Y. COLLECTED: Dec. 5, 1973 BY: Ed Sa v o y BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. Dec. 81 1973 C My Bickwit P. E. D +rector CH PUTIDIM COUNTY DEPARTMIENT OF JEC- 'iLT}r ]) V:i:SIO:T OP ENVIROP!M.T�fITl1)� IiL�'11.,Tx SE RVTCES COUNTY OFPICE BUILDING, CARP:ll?T_,, N., Y. 1a512' 7. DESIGN DATA SHEET - .SEPARATE SEWAGE DISPOSAL• SYSTEM FILE N0. Owner a=eW"rol Ind.nstries Address Rt.; 9. Fisynkill, ., Located at (Street 5; ; a.zF> 4� ,t.*, ty a�l�7.eS9q Block Lot. �Jn.dicate nearest crosss ree Muni•'c:i_palit Watershed ._ OTT. pFR('1nT,AT i ONT Tr,ST nATA PROT1TRM TO Br SUBMITTED WITH APPLICATIONS 2//: off' = O f d,F •1.3 /7 / .17 5//f9 - a9 /a 17 IV � s: 3 - 5 2. , 4. 5 Notes:, 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 'L Bole Number CLOCK TIP• MCOLEiTION PERCOLATION Ran apse Drp t o Wa er Water ve Time From Ground Surface in. Inches Soil' Rate Start -Stop 14in. Start Stop Drop in Min. /'n drop Inches Inches Inches;:F 2//: off' = O f d,F •1.3 /7 / .17 5//f9 - a9 /a 17 IV � s: 3 - 5 2. , 4. 5 Notes:, 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. 'L TEST PIT -.DATA REQUIMEM TO BE SUBMIT`PED WJ:TF[ APPLICATION DESCRIP` -Oi .l Or' SOILS �;;JCGUN`i'F;R1?T� :1`I ''i'ES7.' HULES D .8PTH HOLE NO. _l HOLL NO.. HOLE NO G.L. , 12" ToP3o�L 24" 3011 36" .SAn)n 42" t Go�tM w 48" 54.. \ J� :l2 rr INDICATL LEVEL .AT WHICH GROUND WATER IS ENCOUNTERED A101VX-. INDICATE 10,dFEL. TO WHI^H WATER ".LBVE-L RISES AFTER BEING ENCOUNTERED TESTS MADE. BY Date DESIGN Soil Rate LTSed 6°7 M r�/1 "Drop: S . D.. Usable Area Provided &000+ No. of Bedrooms t:wrea Septic Tank Capacity - ?00 Gals. Type Absorption Area Provided B.Y_Z20 L. F. x24" -- jj " t "h trench. Other Name :,Qegrge Aj V aut ney Signature j Address Dy�lxeman 'Road SEAL - _ ... i THIS SPACE FOR USE BY FEAUVII DE PARTME11T ONLY: I Soil Rate.Approved Sq. Ft /Gal Checked.by Date. INITIAL SITE Yes No � Comments Prop:rty lines or corners found •_✓ . Can estimate house location . . ' , , , Will driveway need cut Must trees be removed -note these . . . . . . ._ _ u.� Is deep hole representative of entire SDS area Add-)' de holes needed. Suffd_cient SDS area-available considering driveway cut, house. location, separation . distances, etc. DEEP HOLE DATA Depth: Water elevation: Rock elevation: Soils description: --_ j Date: - FINA_L, SITE INSPECTION Insp, by:' ' House located where shown on approved plan SM located where approved Slop- of the line and' trench acceptable , Room allm7ed for expansion trenches . , . . , Over 50 ft. from swamp, watercourse . . , . ; -- - "- Natural soil not stripped or SDS area unnecessarily graded . . . . ... . ... . .. . 10 Ft. maintained from prop.line and. 20 ft. from house _ . Separation of trench from house, well etc. follows plan . Number of bedrooms checks . Stones, brush, stumps, rubble, etc. greater than 15 ft. from nearest trench . ; . . . 35 Ft. of pe ripheral soil horizontally from �— trench . . . . . . . Junction bodes properly set Could surface run off from driveway, roads, ground surface, etc. channel near SDS, , area .... Does.lot drainase appear O.K. in area of SDS _ FINAL GRADING OF SITE ACCEPTABLE REVIEVI CHECK SHEET Meets Std. N Ye s o DOCUMENTS House plans O.K. 'Design data sheet Peres presoaked? Min 30" perc,test depth CoDt. results for 3 runs D. Hole log O.K. Corporate Affidavit for other than individual Authorization. for engineer Letter from Water Supply if Applicable.. AA4 If variance requested-such noted on plans & apps. )IT) DETAILS if change is proposed,) -Existing contours shown show new contours) Blopes for driveway cuts, etc. shown Water service line location 0119 1 Footing.,drain,, etc. location Top slope, bottom slope of fill Percolation tests and deep.test pit location Septic tank size and conformance to std. 3 B. R. house. minimum House setback shown "J W_L'ULJill DU I L, r 'U.L r.jj ouuwli lan and profile SDq All other wells and SDS closer 200', shown or reference made I / Property boundaries (metes and bounds-clearly sho n) Remarks SEPARATION DISTANCES SPECIFIED ON Plx'Vi 101 to P.L. 201 to Foundation walls 1001 to Nearest well 50' to stream, march, lake, etc. :Tincl 15'. to Curtain drain 101 to water line (pits-201) 15' to storm drain 101 to large trees 01 1- from foundation to septic tank 5' to pipe from leader drain & fooLir. on r f y . A -. Lj- �tD I. d` 41.